2014 Idaho Medicaid expansion hinges on hard work, new lawmakers

Gov. Butch Otter said last week that building consensus over time was critical to convincing lawmakers to enact a state-run health insurance exchange under the Affordable Care Act this year. Prospects for expanding Medicaid to about 100,000 low-income Idahoans in the 2014 session will rely on a similar effort.

“We understood at the beginning that is was not going to be light lifting,” Otter said of the exchange debate. “We prepared for that, we educated ourselves for it.”

The effort Otter seeks to undertake on Medicaid will include reform measures that give consumers a financial stake in their care and that reward providers for positive outcomes, not simply performance of various procedures.

The 14 House GOP freshmen who backed the exchange could play a key role on Medicaid and have been discussing reform.

A leader of the group, Rep. Luke Malek, R-Coeur d’Alene, said “there’s been a lot a talk about Medicaid,” but that he has no plans to organize a similar coalition that became known as the “Gang of 14.” (The group started off as the “Gang of 16,” but two members backed away and voted against the bill, Reps. Tom Dayley of Boise and Cindy Agidius of Moscow.)

“There’s a reticence to expand a program — which is how it is billed so far — that isn’t necessarily a program we’re fond of,” Malek told me last week. “If it’s truly reform, which we’ve been hearing, that’s a completely different issue.”

Democrats will also likely be part of any winning coalition for Medicaid expansion, as they were on the exchange. They made considerable hay late in the session after a state-commissioned report said expansion would save property taxpayers $478 million over 10 years by lifting the burden on counties to pay for indigent health care.

House Assistant Minority Leader Grant Burgoyne, D-Boise, says 31 newly elected representatives, a record number, brought dramatic change in the culture of the House. In part, Burgoyne said, that’s because they include a number of younger lawmakers like Malek, 31, who take a pragmatic view of “the environment you’re in, not the environment you want to be in.”

“Behind those younger faces are people who are still actively working in the economy, have children at home, have children in college,” Burgoyne said. “They bring a different perspective, which is really important.

“The door has opened on the 21st century a little bit,” Burgoyne added. “We’re not always arguing amongst baby boomers about the ’60s and ’70s anymore.”

Malek said he was pleasantly surprised to have played a significant role in his first session.

“It was a lot of fun, first and foremost, to be involved in policy,” Malek said. “There’s a lot of people that have made it clear that they’re going to make the decision that they think is the best decision. I think that makes for good policy.”

Sen. Fred Martin, R-Boise, is among 13 newly elected senators. Retired and not a member of the younger cohort, Martin nevertheless said he was pleased by the willingness to hear minority viewpoints.

Martin cited a joint meeting of the House and Senate State Affairs committees where advocates of the “Add the Words” campaign made their case on including sexual orientation and gender identity in the Idaho Human Rights Act. They appeared knowing no bill would be introduced, but that significantly lowered tensions from 2012, when refusal to print a bill prompted an outcry at the Capitol.

“This year, they heard them,” Martin said. “There were no protests. This Legislature is probably not going to ‘add the words,’ but they were heard and treated fairly in the process.”

Martin, a member of the Senate Health and Welfare Committee, said he’s surprised to find himself willing to consider expanding Medicaid next year.

“A year ago, I would have said, ‘No way,’” Martin said. “Now, I have a very open mind. It’s a difficult choice for more and more expansion of government. At the same time, we’re already paying for it.”

Dan Popkey came to Idaho in 1984 to work as a police reporter. Since 1987, he has covered politics and has reported on 25 sessions of the Legislature.
Dan has a bachelor's in political science from Santa Clara University and a master's in journalism from Columbia University. He was a Congressional Fellow of the American Political Science Association and a Journalism Fellow at the University of Michigan. A former page in the U.S. House of Representatives, he graduated Capitol Page High School in 1976.
In 2007, he led the Statesman’s coverage of the Sen. Larry Craig sex scandal, which was one of three Pulitzer Prize finalists in breaking news. In 2003, he won the Ted M. Natt First Amendment award from the Pacific Northwest Newspaper Association for coverage of University Place, the University of Idaho’s troubled real estate development in Boise. Dan helped start the community reading project "Big Read." He has two children in college and lives on the Boise Bench with an old gray cat.